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The Objectives of the Study: To evaluate the Antinutritional components, Amino acid profiles and the physic-chemical properties of Hura crepitan (Sand box) seed. Design of the Study: This study was structured to fit into using a combination of T-test and one way Analysis of Variance (ANOVA) to evaluate the data obtained from the laboratory analysis. Place and Duration of Study: This research work was done at the Department of Food Science and Technology Laboratory, Federal University of Technology, Owerri, Nigeria, between May 2019 and November 2019. Methods: The mature dry fruits of the Hura crepitan seeds were harvested from the plants on Federal University of Technology Owerri, Imo State campus. The Hura crepitan seeds were sorted in order to remove dirts and foreign other foreign contaminants. The cleaned seeds were divided into four portions and stored in separate glass containers for further processing. The first portion of the seeds were dried at 60°C in Gallen Kamp moisture extraction oven for 6 hours at and pulverised in a Monilex blended into flour, some seeds were boiled while some portions were roasted and processed into fine flour and subsequently subjected to analysis to evaluate the antinutritional contents, amino acid s as well as determining the physic-chemical properties of the samples. Results: The results obtained suggested that the anti-nutrients in the raw seed-flour were flavonoids with 17.50%, alkaloid (6.20%), tannin (5.24%), and cyanogenic glycoside (1.76%). Fermentation and moist cooking were found to be more effective in the reduction of the anti-nutrients in the Hura crepitan seeds. The amino acid profiles were evaluated, and twenty amino acids were identified in the seed flour. The three major ones implicated were arginine (3.25 g/100 g in cooked and 8.05 g/100 g in fermented), glutamic acid (6.05 g/100 g in cooked and 10.2 g/100 g in fermented) and valine (8.03 g/100 g in raw and 8.58 g/100 g in fermented). The limiting amino acid is methionine with a chemical score of 44.52%. the physicochemical properties of the sandbox seeds evaluated suggested that the free fatty acids values ranged from 3.60% to 6.03% and there were no significant differences (P>0.05) among the samples, the iodine value ranged from 104.94% to 126.90%, the peroxide value for the sample varies between 2.96% to 44.81%. Conclusion: This study suggested that the Hura crepitan seed contains appreciable amounts of essential amino acids as well as having good physicochemical properties while the use of moist heat and/or fermentation can reduce the antinutritional components to the bearest minimum. Hence, can be utilized some areas of food industries where protein (amino acids) are critically required.

Jones Ndubuisi Nwosu, Ethel Nkechi Chime Department of Otorhinolaryngology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria Objectives: To determine the prevalence, types and severity of hearing loss and associated factors in a hospital population of adult Nigerians with diabetes mellitus.Subjects and methods: This study was a prospective hospital-based study conducted at the Otorhinolaryngology and Diabetic Clinics of the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, for a period of 12 months. Consecutively presenting eligible adult diabetics and their age- and sex-matched healthy controls were recruited. Each case and control participant had clinical and otologic examination, followed by pure tone audiometry. Data were analyzed using descriptive and comparative statistics.Results: There were 224 patients and 192 control participants. The patients comprised 112 males and 112 females (sex ratio=1:1), whose mean age was 47.6 years (range: 26–80 years). The prevalence of hearing loss was 46.9%. This comprised 43.8% sensorineural and 3.1% conductive hearing losses. The distribution of hearing loss by severity was mild 25.0%, moderate 15.6% and severe 6.3%. The controls comprised 96 males and 96 females whose mean age was 44.6 years (range: 25–79 years). The prevalence of hearing loss was significantly higher overall and by type (sensorineural hearing loss, conductive hearing loss) in cases compared with controls.Conclusion: The prevalence of hearing loss among diabetic adults at UNTH, Enugu, is comparatively high. Hearing loss is predominantly sensorineural and often mild to moderate in severity. Routine audiometric evaluation of all adult diabetics at UNTH is recommended. Keywords: adults, diabetes mellitus, hearing threshold

Advances in information technology (IT) in the past decade present opportunities and challenges in undergraduate surgical education. There may be need to evaluate the knowledge base and the use of Internet tools among medical students in settings where traditional mode of education is preeminent. This may help to establish a conceptual framework for integrating e-learning into the traditional teaching to enhance learning experience. In this study, we evaluated the medical students’ knowledge and use of Internet tools, and their opinion on the application of these tools in surgical education. We undertook a cross-sectional survey of 2013 and 2014 graduating medical class of College of Medicine University of Nigeria, Enugu using structured self-administered questionnaire. The survey assessed the knowledge, utility, and application of Internet tools in surgical education using 5-point Likert scale. Overall response rate was 78% (227/291) comprising 151 (66.5%) males and 76 (33.5%) females. The median age was 24 years (range 20–33 years). Although 106 (46.7%) had formal training on information technology, 223 (98.2%) can access Internet, and 162 (71.4%) use one or more of the Internet tools, 90.6% (96/106) of those trained on ICT use Internet for education/learning compared to 88.4% (107/121) of those without ICT training (p = 0.76). Google™ search tool had the highest rating in terms of familiarity and utility for education/learning (mean rating 4.3 on a scale of 5.0), while Skype™ had the least rating (mean 2.0). Overall, 89% of respondents (mean rating 4.5 on a scale of 5.0) indicated that Internet tools could be effectively applied in surgical education specifically in areas of lectures, assignments, real-time procedure demonstration, case discussion, and interaction with surgical experts. The key benefits are utility as a regular self-assessment tool (mean rating = 4.6) and offer of flexible learning schedule (mean rating = 4.0). Fifty-two percent (118/227) strongly agree that combination of the use of Internet tools with the traditional teaching may give better learning outcome (mean rating 4.44). The major challenges were cost of accessing Internet (n = 126; 55.5%), lack of facility with the technology (n = 115; 50.7%), and network availability (n = 96; 42.3%). Availability of affordable Internet (n = 205; 90.3%), improvement of training on ICT (n = 135; 59.5%), and encouragement of the use of these tools by faculty (n = 107; 47.1%) were the major suggestions to address the challenges. In our setting, a substantial number of undergraduate medical students are familiar with and use Internet tools for learning and believe that the tools may have utility in surgical education. However, to further consolidate and enhance learning experience, it may be useful to integrate this learning modality with the traditional mode of teaching through a well thought out curriculum modification.

Unrelieved upper airway obstruction from highly prevalent adenotonsillar hypertrophy (ATH) has the potential of producing structural remodelling of the pulmonary vascular bed with resultant pulmonary hypertension (PH) and cor pulmonale. This cross-sectional study aimed to determine the local prevalence of PH and examine its clinical and radiological pointers among children with ATH. The airway obstruction was evaluated clinically by grading the nocturnal and daytime symptoms of ATH. A Brodsky scale and adenoid-nasopharynx ratio (AN ratio) were used to categorize tonsil and adenoid size, respectively. Mean pulmonary artery pressure (mPAP), was measured noninvasively for each child using Doppler echocardiography and PH was defined by mPAP ≥25 mmHg. Comparison of symptom scores, tonsil and adenoid size and demographic factors was made between children with mPAP ≥25 mmHg and those mPAP25 mmHg using univariate and multivariate analysis. There was 22.8 % (18/79) prevalence of PH among the 26 children with only adenoid hypertrophy and 53 with ATH. Significant risk factors identified by logistic regression analysis associated with PH were daytime mouth breathing, daytime stertor, and AN ratio0.75 (P = 0.002, 0.018, and 0.04, respectively), with more than sixfold and fourfold increase risk for daytime mouth breathing and daytime stertor, respectively. Obstructive breathing during sleep was significant only on univariate analysis. Prolonged symptom duration ≥24 months, large tonsils (grades 3 and 4), snoring and mouth breathing during sleep were not significant. This study demonstrated that pulmonary hypertension remains prevalent in children with ATH. Daytime mouth breathing and stertor as well as AN ratio0.75 are the prime predictors of pulmonary hypertension, with an AN ratio cut-off point of 0.73 on ROC analysis.

Vocal cord palsy (VCP) is a major complication of thyroidectomy. Some patients have preexisting VCP prompting the need for routine or selective preoperative evaluation of the vocal cords. The study aims at ascertaining the prevalence of preoperative VCP and making appropriate recommendations. This is a retrospective study of all adult patients who had thyroidectomy at the University of Nigeria Teaching Hospital. Case notes of patients who had thyroidectomy at the hospital from July 2010 to June 2015 were retrieved. Variables studied included biodata, duration of goiter, preoperative hoarseness, outcome of indirect laryngoscopy (IDL), histology of specimen, duration of follow-up, and incidence of postoperative hoarseness. Descriptive statistical analysis was done using SPSS version 20. Of the 91 patients aged 21–70 years (mean 42.08 years, SD 15.40), females outnumbered males with a M:F ratio of 1:10.4. Five patients had preoperative hoarseness, but only three had VCP. IDL was done for 25 (27.4%) patients out of which 22 (88.0%) had normal studies while the remaining three (all from the five with hoarseness) had VCP. Histology of the specimens showed malignancy in 10 (11%), benign in 55 (60.4%), and no report in 26 (28.6%). Five of the malignant histology patients showed normal findings on IDL, three had VCP and two had no preoperative IDL. There was no case of asymptomatic VCP. Vocal cord evaluation is recommended for patients with voice symptoms and those with malignant goiter.

To review the presentation, types and aetiology of ear trauma and various factors affecting ear trauma in our patients over a 5 year period. All patients treated for ear trauma over a 5 year period were studied using their clinical records. Data extracted were analysed using SPSS version 11 software. The results were presented in simple descriptive and tabular forms. Forty-one patients, 18(43.90%) males and 23(56.10%) females were studied, ages 12-43 years, average 26.3 + 5 years. Blows/Slaps (65.85%) from assault was the commonest aetiology while bleeding from the ear (73.17%), hearing loss (70.73%) and tympanic membrane perforation (68.29%) were the most frequent presentations. Ear trauma is common and mostly affects the tympanic membrane. Sudden increase in canal pressure from blows/slaps was the major mechanism of injury. Management outcome was good except for few late presenters with compilations.

Jones N Nwosu, Peter C NnadedeDepartment of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency.Objective: To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution.Method: Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated.Results: Fifty-three patients (37 males and 16 females), age 5–65 years (with mean age of 23.10 years), were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases.Conclusion: Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess.Keywords: septal hematoma, abscess, facial deformity

Foreign body lodgment in ear is a common problem in Otolaryngological practice. An unusual case of seed germinating in the ear of a 9 year old girl out of poverty, neglect and ignorance is presented.

Objective To identify deaths in the surgical wards, elicit the cause of death and suggest changes that will ensure improved surgical care of patients and outcome. Study design Retrospective. Methods Records collected from the theatre operation registers, ward registers and case notes of all patients who were admitted into the surgical wards Federal Medical Centre, Owerri whether elective or emergency from January 1997 to December 2001 were reviewed. Data extracted included date of admission, age, sex, educational status, residence; surgical diagnosis and clinical cause of death Data obtained were analyzed and presented in tabular and descriptive forms. Results There were 4583 surgical admissions in all the surgical wards of which males were 2751 and females 1832. During this period there were 419 deaths with an overall death per admission crude mortality rate of 9.14%. The leading causes of death were acute abdomen (22.20%), RTA with head injury (18.14%) and malignances (14.56%). Of the 419 deaths males were 305 (72.79%) and females 114 (27.21%) in a ratio of 2.68:1. Conclusion Aggressive enlightenment and healthcare campaigns, health education, improvement of healthcare facilities and accessibility to healthcare facilities are highlighted. Structured study in the management of surgical cases is emphasized.

To document our 12 years experience in the management of oesophageal atresia and tracheooesophageal fistula.The study was carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria between January 1997 and December 2008. The paediatric ward and theatre records of patients with oesophageal atresia and trachea oesophageal fistula were reviewed. The data extracted include: age at presentation, age at referral, reasons for delay referral (24 hrs from birth). Associated anomalies, Time interval from diagnosis to intervention, Operative procedure, and outcome.Ten patients were studied, eight males and two females, ratio 4:1. They were all referred from outside the study centre. The average age at presentation was 5.3 days with a range of 2-12 days. The mean age at referral was 3.9 days. Two patients died before surgical intervention. The remaining eight that had surgery done, only one was discharged alive to surgical out patient but was lost to follow up.Delay in arriving at a diagnosis, late referral, associated congenital anomalies and comorbidities contributed to the poor out come. High index of suspicion, early diagnosis and referral, improved facilities and experience of the attending team will make for a favourable out come.

To determine the incidence of postoperative vomiting and fever in patients that had tonsillectomy in our centre over a five year period.The hospital records (case files) of patients that had tonsillectomy with or without adenoidectomy under general anaesthesia at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria from January 2004 to December 2008 were retrieved and analyzed. Patients that had an adenoidectomy only were excluded. The patients were of the American Society of Anesthesiologists (ASA) I to III status.There were fifty two (52) patients that had tonsillectomy and adenotonsillectomy under general anaesthesia during the period under review. Forty one (41) patients were between the ages of 1-13 years (78%) and eleven (11) patients between the ages of 18-62 years (12%). There were 32 males and 20 females. The average age for all the patients was 9.03 years. There were seven (7) patients with post operative vomiting (13.4%). These included four (4) patients in the paediatric population (9.75%) and three (3) in the adult population (27.2%). Twenty one (21) patients (40.3%) developed postoperative fever. There were no deaths The other significant morbidity was postoperative pain.The number of patients that had tonsillectomy in our center was small compared to other studies. The incidence of postoperative vomiting in this study is lower than that reported from Western World, showing possible racial variations, a trend that has been reported in some earlier studies in Black populations.

Objectives: The study was aimed to access foreign body (FB) injuries of the nose, the variety, age group affected, management, and complications as seen in our center. Materials and Methods: It was a retrospective study of 27 consecutive patients with suspected FB in the nasal cavity, seen and managed in the Otolaryngology (ENT) Department of a tertiary health facility in a suburban town, Southeast Nigeria over 18 months. The case notes of the patients in the emergency department, ENT clinic, and ward were consulted for the relevant data that were analyzed and presented in descriptive and tabular forms. Results: Male cases were less than females in the ratio of 1:1.7. All the patients involved were 5 years old and less with an average age of 2.54 years (standard deviation: 0.99). Beads 8 (29.6%) was the most popular FB retrieved. All the FBs were removed in the ENT department without general anesthesia, and no complication was recorded. Conclusions: FBs in the nose were more commonly seen in children. The types of FBs varied along the common objects, the children come in contact with. Seamless removal can be achieved with the right personnel operating in a conducive environment.

Aim: To evaluate the practice of therapeutic Paediatrics bronchoscopy in our environment; to review the anaesthetic practice in our centre, and compare them with universally accepted standards. Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body aspiration was diagnosed clinically and radiologically. Data concerning demography, clinical characteristics, anaesthetics and complications were obtained from the hospital records. Result: A total of 45 patients were studied. They were between the ages of 6 months and 11 years, 29 males and 16 females. A total of 64 procedures were carried out, of which 38 (59.4%) were bronchoscopy. Bronchoscopy was done with Stortz ventilating bronchoscope under general anaesthesia. Repeated doses of suxamethonium were used as muscle relaxant in 92.1% of cases. Conclussion: Rigid bronchoscopy for aspirated foreign body is a safe, effective and often life saving procedure in the hands of experienced anaesthetist and bronchoscopist. A close rapour between the two teams is necessary for a desired outcome. Key words: Foreign body aspiration, Bronchoscopy, Anaesthesia.

Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA) at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom) was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female), 113 (0.002%; males: 54%, females: 46%) were discharged against medical advice. DAMA rate was highest in Surgery (0.4%), and lowest in Obstetrics and Gynecology (0.1%) and Pediatrics (0.1%). Infections (32.7%), trauma (29.2%), and cancer (16.8%) were the leading diagnoses in patients DAMA. Financial constraints (37.2%), unsatisfactory response to treatment (17.7%), and dissatisfaction with hospital environment (15.0%) were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05), patients having high levels of formal education (P < 0.05), and those who had not been previously hospitalized (P < 0.05); but not with age (P = 0.398), gender (P = 0.489), or employment (P = 0.091).Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical characteristics, Nigeria